Fractures in school age children in relation to sex and ethnic background: The Generation R Study

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Fracture rate in childhood is increasing and its consequences may affect health and developmental processes and
cause school absence and restricted activity days. There are scarce epidemiologic studies regarding fractures in
children. The aim of this study was to evaluate if pediatric fractures show disparities across sexes and ethnic
groups. This study was conducted based on data from 3632 participants of the Generation R Study. Prevalent
fractures were assessed using a questionnaire at a mean age of 9.7 years. Child's ethnicity was determined based
on country of birth of the parents using questionnaires (geographic ancestry) or admixture analysis (genetic
ancestry). Associations between fracture occurrence and sex or ethnicity were evaluated using logistic regression
models adjusted for age, weight, lean mass fraction, bone mineral density (BMD) and sex/ethnicity. Fracture was
reported for 525 (14.5%) children. The great majority of these children were classified as European (N = 3164),
followed by African (N = 283) and Asian (N = 185) based on geographic ancestry. Similarly, the highest proportion of Europeans was observed based on genetic ancestry. Prevalence of fractures was not different between
boys and girls, even after adjustment for possible confounders (OR: 1.03, 95% CI 0.84–1.27, p-value = 0.8).
However, odds of prevalent fractures were two times higher in European when compared to Asian children (OR:
2.01, 95% CI 1.17–3.45, p-value = 0.01), and 1.5 times higher when compared to African children (OR: 1.50,
95% CI 1.00–2.26, p-value = 0.05). Overall, in this study, European children showed a highest risk of prevalent
fractures independently of factors such as body composition and BMD, while no difference in the prevalence of
fractures between boys and girls was observed.